Mental-health link is undeniable

Sunday

Dec 23, 2012 at 12:01 AMDec 23, 2012 at 12:55 PM

The tragedy at Sandy Hook Elementary again has brought national attention to the issue of mental health. The killing of 26 people - including 20 first-graders - was almost certainly committed by a young man with a serious mental illness.

The tragedy at Sandy Hook Elementary again has brought national attention to the issue of mental health. The killing of 26 people — including 20 first-graders — was almost certainly committed by a young man with a serious mental illness.

The mental-health community now braces for the predictable spike in fear and stigma associated with mental illness. Past responses to similar tragedies have risked sounding defensive by deemphasizing the relationship between mental illness and violence.

The majority of violent people aren’t mentally ill. Most mentally ill people aren’t violent. People with mental illness are more likely to be victims of violence than perpetrators. Alcohol and drug abuse are potent risk factors for violence more than a serious mental illness alone.

These statements are true, and national experts will offer them with the best intentions. Still, these statements conceal important truths.

An unbiased review of data shows that the seriously mentally ill are at a greater risk of behaving violently toward themselves and others than people with no mental illness. Scientific scrutiny aside, we only have to look at several deadly mass shootings: college students at Virginia Tech, former congresswoman Gabrielle Giffords and her constituents in Arizona, moviegoers in Colorado, and now Newtown, Conn.

Compared to the general population, the severely mentally ill are more likely to abuse alcohol and illegal drugs, have reported histories of violent behavior, delinquency and exposure to domestic violence and childhood abuse. They may have experienced stressors such as victimization, job loss and marital separation. Coupled with mental illness, all are linked to a heightened risk of violence.

Mental illness also can interfere with its own diagnosis and treatment. Individuals with serious mental illnesses, such as schizophrenia, sometimes suffer brain abnormalities that can make it impossible for the individual to recognize that they’re ill and need treatment. Other patients may fear treatment or be convinced it’s pointless. These present challenges in a society that protects individual autonomy and stigmatizes mental illness.

We don’t fully understand the causes of serious mental illness, and existing treatments are wanting. But there is reason for hope. Evidence shows effective treatments are available, and some therapies, including antipsychotic medications, can reduce violent and criminal behaviors. Research suggests a disproportionate number of violent acts are committed by individuals with mental illness before treatment begins or if treatment recommendations are not being followed.

So what can the mental-health community do? We should recognize that mental illness and evil are neither synonymous nor incompatible. We should confront these facts:

• Public policy and investment addressing the link between serious mental illness and violent crime have been neglected;

• The severely mentally ill often resist or don’t follow prescribed treatments, which may reflect the disease process rather than an informed choice;

• Support of autonomy for those with disabling brain disorders may undermine the public health and well-being of affected individuals;

• Funded research, improved illness recognition and development of effective treatments for mental illness and substance abuse are the best hope to prevent violence and minimize stigma for the seriously mentally ill.

E. Fuller Torrey, a psychiatrist, schizophrenia researcher and advocate, summarized the valley between the mental-health establishment and the public: “It is as if we are experiencing a flood, but we professionals are fooling ourselves and averting our eyes from the source of the water. The public knows better. En route to work, they glance at the poster proclaiming that mentally ill people make good neighbors. Then they see the news about the latest violent act by an untreated person with mental illness. The public knows which one to believe.”

We need increased funding of mental-health research, better treatments and public policies based on our current knowledge of serious mental illnesses. We need expanded access to mental-health services from crisis assessment and emergency services to residential treatments.The time for all of us to get serious — deadly serious — about the relationship between severe mental illness and violence is now.

Dr. John V. Campo is chairman of the Department of Psychiatry at Ohio State University and chief of psychiatry at OSU’s Wexner Medical Center.